Project No: _________________
CSJ: ______________________
LG: ________________________
Contractor: ___________________
Bid Amt: $____________________
Contract Administration Checklist
All Forms and information are available on the TxDOT website under “Doing Business With TxDOT”
Assign a “Responsible” and “Qualified” person(s) from the LG to the project. The
“Qualified” person must have completed the Local Government Project Procedures
(LGPP) Training Course. The LGPP is available for review online at: http://www.txdot.gov/inside-txdot/office/local-government-projects.html
Responsible Person: _____________________________
Qualified Person: _______________________________
Estimate Package – to be submitted to TxDOT MONTHLY
Form 132 – Billing Statement
Project Worksheet (or LG Entity equivalent approved by TxDOT)
Copy of cancelled check of payment to Contractor
Provide the “Notice to Proceed” letter from the LG Entity to the Contractor. Please copy
TxDOT when this letter is sent.
Form 252 – Contract Time Statement (or LG Entity equivalent approved by TxDOT).
The LG Entity should forward this to TxDOT in their MONTHLY reimbursement request.
No. of Contract Day: ________
Est. Start Date: _____________
Charged as: ________________
Est. Completion Date: _____________
On projects with pedestrian elements in the amount of $50,000 or greater, request a
TDLR Inspection and provide the approval letter to TxDOT.
Bulletin Board Checklist – ensure all required posters are placed on a bulletin board that is open and available for all employees.
Buy America – Because Federal Funds are involved in this project, ensure that your
Contractor and Subs know that iron and steel products to be incorporated into the work as shown on the plans are all required to be manufactured in America.
Subcontractor Approval Form – The Contractor will submit this completed form for each
Subcontractor they intend on using at any point during the project. These Subcontractors should be submitted to TxDOT for pre-approval prior to beginning work on the project.

Change Orders – LG is to provide a copy of every change order to TxDOT for review and written concurrence before the work is performed, including additional items of work, time extensions, and/or differing site conditions. At TxDOT’s discretion, verbal approval may be provided for change orders for emergency and minor items. Change orders for emergency and minor items should be submitted to TxDOT for review and written concurrence as soon as practicable.
DBE Reports – monitor DBE participation according the goal specified in the contract.
Memo of Understanding (MOU) – If the Local intends on using the TxDOT DBE
Program, obtain documents from the Office of Civil Rights DBE Section (512-
486-5500).
Form 4901 – DBE Commitment Agreement; this form is to be completed by the
Contractor and reviewed by the LG Entity for acceptance before work begins.
Form 4903 – DBE Report; this form is to be completed by the Contractor and submitted to the LG Entity MONTHLY. The LG Entity should forward this to
TxDOT in their MONTHLY reimbursement request.
Form 4904 – FINAL DBE Report; this form is to be completed by the Contractor once the project is completed and submitted to the LG Entity.
Form 2182 – Commercially Useful Function (CUF); this form is to be completed for every DBE Subcontractor that works on the project and forwarded to TxDOT for review after completion.
DBE Goal: ___________%
SWPPP – This is to be performed in accordance with TxDOT policy and forwarded to
TxDOT in their MONTHLY reimbursement request.
Form 2118 – SWPPP Inspection; this form is to be completed by the LG Entity
PM or Lead Inspector every 14 days or after 0.5” rainfall.
SWPPP Inspection Log
FHWA Form 1391 – If work is performed during the month of July, FHWA Form 1391 must be completed by all Contractors and Sub-contractors and submitted to the LG
Entity. The LG Entity should then forward to the TxDOT Project Manager by August
15.
Liquidated Damages – LD’s are to be assessed in accordance with specification included in the contract documents. If the LG Entity fails to assess LD’s and TxDOT finds that
LD’s should have been charged, the LG Entity may be liable for the charges and reimbursement for that amount may be withheld from reimbursement.
Liquidated Damages set at: $_________ per day
FHWA Form 1273 – This document is included in your contract documents and should be reviewed at length to ensure compliance with all Federal Requirements. http://www.fhwa.dot.gov/programadmin/contracts/1273/
Payrolls – The Contractor and Subcontractors should provide weekly payroll reports to the LG Entity so that the LG Entity can ensure that the Minimum Wage Rates included in the contract documents are being followed.
Form 2220 – Labor Interviews: LG Entity should complete and document three
(3) interviews per quarter for the duration of the project.

Form 2177 Prompt Payment - to be completed by the Contractor and submitted to the LG
Entity MONTHLY. The LG Entity should forward this to TxDOT in their MONTHLY reimbursement request.
Quality Assurance Program - http://www.txdot.gov/business/resources/materials.html
Submit Concrete and HMA Designs to the TxDOT Project Manager for review and approval prior to beginning work.
Submit the LG Entity’s QA Program and testing procedures to ensure testing will be done according to Federal and TxDOT minimum requirements. See Guide
Schedule for Sampling and Testing [27] or online.
Request the Contractor to provide documentation to ensure all materials intended to be used on the project will be from a TxDOT approved source.
At project completion, submit a letter of certification sealed by a licensed engineer that all materials incorporated into the project are in conformity with the approved plans and specifications to TxDOT.
Form 599 – Barricade Inspection Report: this report should be done twice monthly (one day and one night) and provided to the Contractor for review and signature, and the
Contractor is to correct any deficiencies. Keep Inspection Reports in a separate file labeled “DO NOT DISCLOSE – EXCEPTED FROM DISCLOSURE BY 23 USC
§409”.
TxDOT should review these documents at least quarterly at the location they are retained by the LG Entity.
Project Records – To be audited quarterly and/or at the project’s completion.
Daily Diary / Daily Work Report (DWR) – The PM or Lead Inspector for the LG should be documenting project progress and work daily. Use the TxDOT provided form or the LG Entity’s equivalent approved by TxDOT.
Form 1257 – Work Report: this form will be used document each installment for each pay item. Properly document measurements and/or calculations.
Form 1258 – Work Summary Report: this form will be used to track the running total of installments documented on Form 1257.
Retain materials tickets for all materials delivered on the project and ensure that each item is being provided from a TxDOT approved source.
Final Acceptance Report / Letter – provide documentation to TxDOT that the LG Entity has accepted the project and is satisfied that all items of work have been completed.
At project completion, submit a letter of certification sealed by a licensed engineer that the project was built in conformity with the approved plans and specifications to TxDOT.
Complete TxDOT Summary of Best Practices (initial section of this document).
Complete copy of Contract Administration Checklist (this checklist).